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Coronavirus (COVID-19) Early Learning and Child Care Practice Guidance

June, 2020

Contents

Updates ........................................................................................................................... 2

Public Health Resources ................................................................................................. 3

Prevention Measures ...................................................................................................... 3

Screening ..................................................................................................................... 3

Visitor Access .............................................................................................................. 5

Public Health Measures ............................................................................................... 5

Day-to-day care during COVID-19 ................................................................................ 11

Health Concerns and how to address them .................................................................. 14

What happens if a child exhibits symptoms? ............................................................. 14

What happens if a staff member exhibits symptoms? ................................................ 15

Documentation ........................................................................................................... 17

Additional Resources .................................................................................................... 17

Resources on Talking to Children about COVID-19 ................................................... 18

Appendix A – COVID-19 Incident Reporting Form ........................................................ 19

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Updates [June 23, 2020] Manitoba Families is committed to providing updated information as it becomes available through this practice guide. For the most up to date general information and public health direction, please refer to www.manitoba.ca/covid19. All updates will be highlighted in this section and integrated into this practice guide and shared with facilities.

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Public Health Resources

The COVID-19 situation continues to evolve in Manitoba. The provincial website www.manitoba.ca/covid19 will continue to provide up-to-date information, so please check this site regularly. All screening that identifies suspected cases of COVID-19 should be referred to Health Links at 204-788-8200 or 1-888-315-9257.

Prevention Measures All facilities providing child care must continue to follow applicable health and safety legislation to ensure the safety, health and well-being of children. This includes all standards within The Community Child Care Standards Act and Child Care Regulation, and guidelines within the Best Practices Licensing Manual for Early Learning and Child Care Centres. The safety and wellness of staff is paramount. The following modifications are applicable to current policy and practice requirements. These instructions will be adapted as Manitoba Health, Seniors and Active Living (MHSAL) guidance to Manitobans evolves. Additional information will also be provided through circulars from the Child and Youth Services Division. Facilities should strengthen communication strategies (including signage) about when to stay home. Individuals should self-isolate and not enter child care centres if they:

are experiencing symptoms suggestive of COVID-19,

have travelled outside Manitoba in the previous 14 days,(Public Health Orders currently exclude locations in: Western Canada, the territories, and Ontario – west of Terrace Bay),

are a close contact of a confirmed case of COVID-19, or

are awaiting a COVID-19 test result (excluding persons tested as part of voluntary asymptomatic surveillance for COVID-19 that do not need to isolate).

An up–to-date list of symptoms can be found at https://www.gov.mb.ca/covid19/about/index.html Anyone who is unsure whether they or their child should be tested and self-isolate, should be directed to the COVID-19 Screening Tool at https://sharedhealthmb.ca/covid19/screening-tool/

Screening

Screening for symptoms is important to identify any potential cases of COVID-19 as quickly as possible, before exposure to others.

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Staff No staff member who has symptoms or is otherwise required to self-isolate should enter a child care centre. In addition, staff should self-monitor daily for signs and symptoms of COVID-19. Staff that have an elevated temperature or any symptoms of COVID-19 must stay home, isolate and be excluded from work. Facilities must maintain records of staff absenteeism. Children Child care centres should develop a plan to clearly communicate to families the need to monitor their child daily for symptoms before sending them to child care. Signage with exclusion criteria should be posted at all entrances to the facility. A child who meets any of the exclusion criteria will not be admitted to the centre and will be advised to immediately isolate and consult Health Links - Info Santé or their health care provider. Those with symptoms should be tested, and if negative for COVID-19 they can return 24 hours after symptoms resolve. If individuals choose not to be tested, they should isolate for 14 days from symptom onset, and may return if symptoms have resolved at that time. Parents/guardians should be asked daily to confirm that their child has no symptoms and is not otherwise required to self-isolate. Child care centres are not required to screen children for specific symptoms or take temperatures of children upon arrival. A chronic stable cough, sneeze, runny nose, or nasal congestion that is unchanged and clearly linked to a known medical condition such as asthma or allergies is not an absolute requirement for exclusion. As well, children who are crying or teething can exhibit a runny nose. Changing or worsening of chronic symptoms requires isolation and contacting Health Links - Info Santé. Child care providers should exercise judgment related to symptoms but when in doubt, err on the side of caution, exclude the child and advise the parent/guardian to contact Health Links – Info Santé or their health care provider. Guidelines may change based on emerging circumstances and information from public health officials. Visit www.manitoba.ca/covid19 for information on prevention, and updates on the evolving situation. Temperature Measurement: Routine screening or monitoring of temperatures with a thermometer or other device to assess for fever is not recommended. Normal temperatures can be variable throughout the day and can be different between individuals. We recommend that parents and staff focus on monitoring for symptoms of COVID-19 as outlined in the Screening Tool and poster at https://sharedhealthmb.ca/covid19/screening-tool/.

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Visitor Access Visitors or volunteers are permitted. Parents/guardians are able to volunteer but must adhere to physical distancing and recommended hygiene practices when on the premises. Other volunteers are permitted, but it is recommended that these are limited to those who regularly volunteer to minimize the number of possible exposures outside the centre. Before entering a child care centre, visitors should be directed to complete the screening tool to confirm that they have no symptoms consistent with COVID-19 and are not required to self-isolate. Visitors with any symptoms consistent with COVID-19 should not enter the child care setting. Child care settings are required to keep a list of all essential visitors that entered the facility with confirmation that they have been screened.

Public Health Measures

COVID-19 is most commonly spread from an infected person through respiratory droplets generated through coughing, sneezing, laughing, singing, and talking. It spreads more easily when contact is close (within six feet / two metres) and prolonged (more than 15 minutes). COVID -19 can also be spread by close personal contact such as touching or shaking hands or touching something with the virus on it and then touching one’s mouth, nose or eyes before cleaning one’s hands. Some people who have few or no symptoms can spread COVID-19. Although public health measures can significantly reduce the risk of COVID-19 entering and being transmitted in child care settings, the risk is never zero. It is important to remember that while children tend to have less severe disease, this is not always the case. COVID-19 can also cause more severe illness among people who are 60 years of age and older, and those who have weakened immune systems or underlying medical conditions. Children under one year of age and those with immune suppression and chronic medical conditions are considered more vulnerable and at higher risk for severe illness. Parents/guardians and staff are encouraged to consult with their health care provider if they have concerns about their own health, their child’s health, or health of other household contacts. The most effective measures to reduce the spread of COVID-19 include separating people by maintaining physical distance and the use of physical barriers. However, these measures are not always practical in child care settings. Therefore it is most effective to use a layered approach including multiple measures from the areas listed below, and to develop administrative measures that support individuals to consistently follow personal preventive practices (e.g., environmental cleaning, conducting frequent hand hygiene) that decrease the number of interactions while increasing the safety of interactions that occur. Adapted responses and recommendations may be required in situations where health, age, ability, status, or other socio-economic and demographic circumstances may limit the ability of some groups or individuals to follow the recommended measures.

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Staff and children can take actions to limit the spread of COVID-19. Some of these are already part of the quality care provided through facility programs. However, special attention should be used to ensure they are followed.

Physical (social) distancing: Physical distancing of two metres / six feet between all individuals should occur whenever reasonably possible in a child care setting. This is applicable for both indoor and outdoor play, and during pickup and drop-offs. If maintaining distancing in a group is challenging due to the children’s ages, then it is reasonable for individuals to be closer to one another when necessary (i.e. a staff member may need to be closer to a child to maintain line of site when moving a group or at nap time) as long as physical distancing between groups is maintained. Where physical distancing cannot be maintained between individual children, it is important to maintain at least four meters between groups or cohorts of children (i.e. two groups of children can be in the same room provided the groups do not intermingle and provided four metres of space is maintained between the two groups). When working in this setting:

Children with no symptoms should continue to be treated as they typically would be treated by staff, but with physical distancing in place as much as possible.

Where possible, arrange spaces to encourage the recommended separation. For example, spacing children to avoid close contact during meal and nap times, and assigning a designated chair and table for each child.

Signage should be posted to promote physical distancing. Remember that young children need easy to understand visual prompts. For example, use tape on the floor, hoops, mats or other items that can mark off personal space. Another idea is to organize play activities with a visual cue about how many children should be in that area (e.g., two chairs next to an activity with markers or numbers taped to the floor).

Minimize the number of individuals entering the facility by having only one family member pickup and drop off their child(ren). Where appropriate, consider doing drop off and pick up outside the facility, implement a practice of staggered drop off and pick up times, or use separate entrances (if feasible).

Stagger staff break times.

Physical barriers can be used when physical distancing cannot be maintained, where appropriate. Consider the need for additional cleaning and sanitizing of any barriers or dividers.

Plan for play experiences that help children learn why it is important to maintain appropriate distance between each child. Depending on the age of children, possible activities include:

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Use masking tape to create squares or other shapes that are two metres apart. Have children move from shape to shape while the music plays as a sort of musical chairs.

For older children, introduce coding activities - e.g., set up a grid of two-metre sized squares, using masking tape. Count the squares, explore concepts of rows and columns, and then encourage children to take turns being the computer and the computer programmer. Consider using a variety of cards, including arrows.

Provide measurement activities - e.g., provide yardsticks, measuring tapes or rulers (which can be taped together). In absence of these, use lengths of cardboard pre-measured into metre-long lengths, or yarn or rope cut in pre-measured lengths. Measure tables, distance between, etc.

Promote gross motor measuring activities involving different lengths.

Play “What time is it, Mr. Wolf?” The wolf stands against a wall. A line on the floor indicates a two-metre distance from the wolf. Intersecting grid lines space children so that they are two metres apart. Alternatively, children can approach the wolf one at a time, while not going beyond the two-metre line.

Set up a ball or bean bag toss, with the line two metres out from a target bucket.

Cohorting/Grouping: If groups can be kept separate, then child care centres may operate at full capacity, even if the total number of children (adding up all groups) exceeds the maximum under current public health orders for indoor and outdoor settings.

The maximum number of individuals congregating (i.e. close interactions between people longer than 10 minutes) in a common space for indoor and outdoor settings must comply with the most up to date public health orders (https://www.gov.mb.ca/covid19/soe.html#current). Minimizing in the use of common spaces wherever possible will help reduce the risk of COVID-19 transmission.

The following guidelines should be followed:

Where physical distancing cannot be maintained between individual children, it is important to maintain at least four meters between groups of children (preferred) or cohorts of children (i.e. two groups of children can be in the same room provided the groups do not intermingle and provided four metres of space is maintained between the two groups).

Whenever possible, assign children and staff to a group and keep them together throughout the day.

For childcare centres with larger total numbers of children on site, each cohort or maximum total group size should be no more than 30 children. Smaller group sizes are preferable.

Where possible, staff and children should remain with the same group each day.

Siblings should be grouped together when reasonable (e.g. siblings are within the same age range). Siblings are not required to physically distance from each other

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(e.g. siblings can hug, be within two metres/ six feet of each other), even if they are in different groups within the childcare setting.

Groups should not be in shared spaces (including indoor and outdoor, hallways, entrances, foyers) at the same time (e.g. stagger individual group times on the playground). Where this is not possible, physical distancing between groups is required.

Child care settings should keep daily records that include the names of the children and staff participating in each group.

Limit staff to one site, if possible. Drop off and Pick up:

Drop off and pick up of children should be staggered to avoid crowding. A maximum number of 25 at one time is suggested.

When it is not possible to stagger pick up and drop off times at entrances and exits, then a greater number of individuals may use the same entrance or exit at the same time, as long as close interactions between individuals are brief (less than 10 minutes, ideally shorter).

Hygiene Practices: Handwashing with soap and water for at least 20 seconds is the recommended hand hygiene practice in child care. The use of alcohol based hand sanitizer can be used by adults in the facility (see note below). Specifically, staff, volunteers and children must engage in frequent hand hygiene often, including but not limited to the following times:

at the start of the day and before going home,

after going to the washroom and helping children with washroom routines

after a diaper change (both children and staff),

before and after preparing food,

before eating/drinking,

after getting hands dirty or you feel they have become contaminated,

after wiping nose or handling dirty tissues,

after coughing, sneezing and blowing nose,

after soothing a crying child, and

after cleaning tasks (staff). Note: Alcohol-based hand sanitizer is not recommended for routine use in child care, but it should be available on site to be used by adults (staff, parents/ guardians). However, if hands are visibly soiled, they should be washed with soap and water rather than an alcohol-based hand sanitizer. Provide sanitizer with a minimum alcohol concentration of 60 per cent in areas throughout the facility, such as entry points. Ensure these are situated so that children cannot access it without supervision. Child care staff should help young children to ensure handwashing is done correctly.

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Good hygiene practices can be taught in a playful manner. One idea is to have timers to help ensure adequate time. See how many 20-second songs the children can identify. Be creative - engage the children in coming up with games and other ways to encourage everyone to wash their hands for 20 seconds. Respiratory etiquette should be modeled, taught and reinforced regularly. This includes coughing and sneezing into a tissue or sleeve, as well as proper and prompt disposal of any used tissues followed by hand hygiene. No personal items (e.g. hats, hair accessories, lip balm, food/drinks) should be shared. Avoid touching your mouth, nose or eyes, and encourage children to do the same. As part of these routine measures, signage should be posted and highly visible and include visual cues that remind staff and children to perform hand hygiene (e.g., sneezing or coughing into their elbow, putting used tissues in a waste receptacle and performing hand hygiene immediately after using tissues). Signs can be found at: https://www.gov.mb.ca/fs/childcare/resources/pubs/posters.pdf .

Environmental Cleaning: Child care facilities must engage in frequent, thorough cleaning and disinfection every day throughout the facility (including cribs, cots, toys and where possible outdoor play equipment). More frequent cleaning and disinfection of high-touch surfaces (e.g. doorknobs, railings, faucets, tables, light switches, electronics, etc.) is required (twice daily or more often as needed). Please refer to the Best Practices Licensing Manual https://www.gov.mb.ca/fs/childcare/resources/pubs/elcc_manual.pdf for required cleaning and disinfection procedures. Health Canada has a list of disinfectants shown to be effective against COVID-19 available at https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html. Care providers are encouraged to review existing activities and practices within their settings to help determine where enhancements or increased cleaning frequencies may be beneficial. This includes limiting use of high touch objects and surfaces by multiple individuals (e.g. providing children with their own containers of art and crafts materials that are not shared with others). Waste should be disposed of regularly. Hand hygiene should be performed after waste removal. No-touch waste receptacles are preferred. Increased monitoring of hand cleaning supplies is recommended to ensure all sinks in washrooms, kitchens and laundry areas are well-stocked with hand hygiene supplies at all times (i.e., soap, alcohol based hand sanitizer and single-use towels). This includes hand lotion to prevent dermatitis (i.e. dryness, irritation, itchy, cracked hands) and maintain a good skin barrier for healthy hands (including fingernails) and skin. Public health recommends applying a fragrance-free moisturizer or barrier cream with

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Dimethicone, silicone, ceramides or ointment with petrolatum (*avoid use of petrolatum based hand lotion when using latex gloves). Follow a regular laundry schedule. Items/clothing should be laundered regularly in hot water and thoroughly dried. Soiled facility linens/towels should be laundered using regular laundry detergent and hot water. Any soiled bedding or clothing belonging to a child should be bagged and sent home with the family for laundering. If the laundry container comes in contact with contaminated laundry, it should be cleaned and disinfected. Perform hand hygiene after handling dirty laundry. Toys: As per standard procedures, it is recommended that facilities have toys that are easily cleaned and disinfected. It may be prudent to increase the frequency of the cleaning schedule for these items, especially when illness is circulating in the setting or the local community, or if symptomatic staff and children have been touching the toys. Plush toys should be avoided. Children’s personal toys (i.e. for security or comfort) are not to be shared with other children and should be stored in a way that ensures this. In general, sensory play must not be used at this time. Children should not use or handle play dough, indoor sand and sensory tables, as these items cannot be easily disinfected. An exception can be made for children with additional support needs where the use of these items is an important part of their individual plan. This items should then be used under staff supervision and exclusively by the individual child. Food handling: The best practice is that parents/guardians provide their own food for their child. If this is not possible, the following guidance applies:

Staff should serve all food items.

Utensils should be used to serve food items by staff, not fingers.

Remove shared food containers from eating areas (e.g., snack bowls, pitchers of water or milk, salt and pepper shakers).

If using single service packets of condiments, provide the packet directly to each child, rather than self-serving from a bulk container.

For snack programs, dispense snacks directly to children and use prepackaged snacks only.

Close kitchen and nourishment areas that could be accessed by children or visitors.

Cease activities involving child participation in food preparation.

Implement other measures as necessary or appropriate, or if directed by local public health.

Ensure that food handling staff:

practice meticulous hand hygiene

are excluded from work if they are symptomatic

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Child care centres may provide meals for children if they have a full kitchen with dedicated kitchen staff. No family-style, buffet or potluck meal service is permitted at this time. "No sharing" policies: It is important to reinforce no food or water bottle sharing policies for children. Generally, these policies are intended to reduce potential exposures to allergens, but the practice of not sharing food or water bottles in child care facilities also helps reduce virus transmission between staff and children.

Day-to-day care during COVID-19

Reassurance Provide reassurance to children and youth about their personal safety and health. Telling children that it is okay to be concerned is comforting. Reassure them about their safety and explain there are many things they can do to stay healthy:

Hand hygiene: Perform hand hygiene often with soap and warm water for at least 20 seconds, or use an alcohol-based hand sanitizer (by adults), especially after coughing, blowing noses or sneezing, and when handling food.

Cough and sneeze etiquette: Cough and sneeze into your arm or tissue. If using a tissue, immediately dispose of the tissue and perform hand hygiene afterwards.

Stay home when sick: Children should tell staff if they are not feeling well and together make a plan to stay home from school or other activities.

Keep clean: Do not touch your face, particularly your eyes, nose and mouth.

Stay healthy: Stay healthy by eating healthy foods, keeping physically active, getting enough sleep and fresh air.

Print the Healthy Practices Poster Series – in particular, the hand hygiene and sneezing posters – and place them around your centre. School-aged children can be encouraged to create their own. Visit https://www.gov.mb.ca/fs/childcare/resources/pubs/posters.pdf to access this information. Communication Children want to be heard. They do not need detailed information about events, but they do need to talk about their feelings. Let them know they can ask questions. Answer questions honestly, but make sure that the information is suitable for their age level. If you do not know the answers to their questions, it is okay to say so and together look for resources that can answer their questions. Remember that children are often listening when you talk to others about COVID-19. Staff should consider this and minimize discussions of COVID-19 that are not related to the child care setting.

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Staff should be mindful of how children share information in less supervised settings (e.g. during outdoor play, before and after school, lunch and snack times). In these settings, children can become misinformed. It is important for staff to correct this misinformation as they become aware of it. At this time parents are increasingly focused on the safety and wellbeing of their child(ren) while they are in the care of staff in child care settings. They expect clear communication from staff when they have questions about their child and about how the facility is implementing public health guidance. Parents have more access to misinformation, which makes it important for staff to remind parents to use official sources for the most up-to-date and accurate information, www.gov.mb.ca/health/coronavirus/index.html . Staff can reassure parents that Manitoba’s early learning and child care (ELCC) facilities and services are safe for children. Child care centres and homes consistently follow preventative practices, including environmental cleaning, frequent hand hygiene and routine screening. The ELCC program continues to work closely with public health to ensure that all ELCC operating practices and procedures are up-to-date and reflect the most current health management information that is available to the department. More on talking to children about COVID-19 is available in the additional resources section. Activities Maintaining familiar activities and routines will reinforce the sense of security of children. As every child care provider knows, play is a priority – it promotes physical and mental health and development and gives kids an outlet for their energy, concerns and emotions. The current situation presents many challenges for group play, but can also be a source of creativity. Spread children out as much as possible with small groups in different rooms, or have a group outside while another is inside, as another way to encourage physical distance. Consider the equipment and play materials. Conduct an assessment of play materials currently available and remove those that are harder to clean and sanitize. Keep a bucket or laundry basket close by for items to be deposited when they need to be cleaned. Consider activities where children can do something to learn about and support all the people working to keep others safe and healthy:

Talk about people in their neighbourhood or community and the role they are playing (e.g., mail carriers and grocery clerks, doctors and nurses).

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Young children could create art work to post in windows to say thank you to health care workers, paramedics, other essential workers (truck drivers, grocery store clerks), etc.

Older children could write a thank you song or a short play, then videotape a performance to send to essential workers

Children could connect virtually with children at another centre to perform their songs for each other or perhaps collaborate on something.

Depending on the age of the children in the centre, they will have ideas and suggestions. Discuss the concept of physical distancing, using a visual such as a string. Brainstorm with them, asking for their ideas in terms of coming up with ways they can play, and activities they think will allow an appropriate distance. Ask them about some of the typical experiences that are part of their typical day (e.g., circle time and snack), or areas in the playroom (e.g., housekeeping or block areas). Give them scenarios - "How could you play in the block area" – and use the string to try out their ideas.

Outdoor Play: Move activities outdoors if possible, and schedule outdoor play to maintain cohorts of children and staff. Getting outdoors for walks or to the park or nearby trails with the children is encouraged. Children may play on play structures or play equipment (e.g. tire swings, play houses) as long as physical distancing (no crowding) can be maintained and they clean their hands before/after. Children, staff and volunteers should perform hand hygiene before and after returning from outdoor play. Sharing toys in an outside setting (e.g. sand box) is permitted, as long as effective hand hygiene can be ensured before and after the play. However, younger children with a lot of hand-to-mouth activity should not be permitted to share toys in an indoor or outdoor setting. If possible, designate space and toys within the play area for each cohort. Outdoor play areas and toys should be cleaned and disinfected between use as per regular cleaning and disinfection procedures. When visiting public outdoor green spaces, avoid using public water fountains. Children should bring their own prefilled water bottle to these activities. Remember to have everyone clean their hands when they re-enter the centre. Other outdoor activities where physical distancing can be maintained are also permitted (e.g., composting, gardening). Sports: Indoor or outdoor non-contact sports (e.g. tennis, soccer) are permitted as long as physical distancing can be maintained during the play, except for brief exchanges of close contact. Choose outdoor settings as much as possible, as they are lower risk for transmission of COVID-19. A more detailed document has been developed to provide guidance on how sports and other activities could be modified/adapted to reduce the transmission of COVID-19. You can find this at: https://www.gov.mb.ca/covid19/restoring/sports-guidelines.html.

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Outings/Field Trips: Field trips or outings are permitted, however, the participation of children must be entirely voluntary when accompanied by appropriate parental permission. Enhanced planning for outings and field trips will be necessary to ensure the health guidelines are met. Trips to spray pads and other local centres such as libraries and community centres are permitted, provided they follow the applicable guidelines, as well as requirements around social distancing and capacity. When planning outings/field trips, consider the following:

Outdoor settings are lower risk for transmission of COVID-19.

Avoid crowded venues where physical distancing of 6 feet (2 meters) cannot be maintained.

Locations with high touch surfaces are higher risk for transmission of the virus (outdoor settings have lower risk for this).

Ensure there is access to hand washing and/or alcohol-based hand sanitizer during the outing. Handwashing will be required if the activity involves getting the hands soiled.

For group transportation, physical distancing needs to be maintained (i.e. one child per seat on a bus).

Avoid using public water fountains. Children should bring their own prefilled water bottle to these activities.

Activities with animals/pets: Animals and pets are permitted as per child care regulations. Children and staff who handle animals should perform proper hand hygiene before and after handling animals. (see Hygiene Practices section above). Ensure animal handlers who are visiting the facility are screened following processes for visitors, and ensure physical distancing is possible between the animal handler visitor and the child. Medical or non-medical masks may be worn by the visitor as an additional precaution.

Health Concerns and how to address them

What happens if a child exhibits symptoms?

If a child develops symptoms while at the facility, the child should be isolated in a separate room. If a separate room is not available, the child needs to be kept at least two metres/ six feet away from other children and staff. If possible, a mask should be provided to and worn by the sick child (> 2 years of age only). The parent should be notified to come and pick up the child immediately. Ask the parent or guardian to contact Health Links – Info Santé (204-788-8200 or 1-888-315-9257) or the child’s health care provider for direction, if required.

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If the child is young and requires close contact and care while isolated, caregivers can continue to care for the child until the parent is able to pick-up the child. Caregivers should be mindful of hand hygiene and avoid contact with the respiratory secretions of the child. A medical mask should be worn by the staff person caring for the child. Additional environmental cleaning should occur. Focus should be in high-touch areas and areas where the child spent time. All items (e.g., bedding and toys) used by the child while isolated, should be cleaned and disinfected as soon as the child has been picked up. A sick child can return to the centre once it has been determined that it is safe to do so by their health care provider or public health. If that child has a positive test, further direction will be provided by a public health nurse. Public health typically follows up with contacts of cases within 24 to48 hours. If there is no notification by public health within that time frame, you can assume no contacts within the centre have been identified or the sick child has been confirmed not to have COVID-19.

What happens if a staff member exhibits symptoms?

Staff should use the self-assessment tool before attending work, and be directed to stay home if they are feeling unwell. If a staff member or volunteer in a child care facility becomes symptomatic, they should immediately isolate themselves from other staff and children, notify their supervisor and go home to isolate. They should then contact Health Links - Info Santé (204-788-8200 or 1-888-315-9257) or their health care provider for direction. Additional environmental cleaning should occur. Focus should be in high-touch areas and areas where the staff/volunteer spent time. Staff members who are away sick, or self-isolating, must follow the facility’s human resource policy on being away from work. A sick staff member can return to work once it has been determined that it is safe to do so by their health care provider or public health. If that staff has a positive test, further direction will be provided by a public health nurse. Public health typically follows up with contacts of cases within 24 to48 hours. If there is no notification by public health within that time frame, you can assume no contacts within the centre have been identified or the sick staff member has been confirmed not to have COVID-19. Outbreak Management In the event that a case of COVID-19 is confirmed to be connected to a child care centre, public health will provide additional guidance including ensuring that appropriate supports are in place to coordinate the response. One (1) confirmed case of COVID-19 in a child care setting would be considered an outbreak.

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Public health actions and directions may include, but are not limited to:

contact tracing, which involves identifying contacts of a positive case and contacting those individuals,

requesting records that identify cohorts/groups of staff and children in the child care setting for a specified time frame,

testing of staff and children that may have been exposed to a positive case,

enhancing environmental cleaning, and

assessing need for facility closure.

Child care centres are expected to work with public health to ensure a prompt response to cases of COVID-19 that may have been exposed in or may have attended a child care centre. Personal Protective Equipment (PPE) Children are not required to wear masks or other PPE in child care settings. Staff should maintain current practices for the use of PPE with respect to the hazards normally encountered in their work, with the exception of wearing a medical mask (surgical/procedural mask) when unable to maintain a distance of two meters / six feet from a child who is exhibiting signs or symptoms suggestive of COVID-19. There is no role for the use of N95 respirators in this setting. Glove use is only required as per your regular practices and current policies. To don (put on) the mask safely, perform hand hygiene by handwashing with soap and water or use an alcohol-based hand sanitizer. Place the mask on your face carefully so it covers your mouth and nose, handling it with the strings/elastic ear loops as much as possible, and mold the nose bridge to ensure it does not move while on. Avoid touching the mask once you have put it on. If you need to adjust it, clean your hands before and after adjusting the mask. Never pull the mask down below your nose or mouth and chin. Never dangle the mask from one ear or both ears. To remove the mask safely, remove the mask from behind using the strings/elastic ear loops; do not touch the front of the mask. Discard the mask immediately, ideally in a no touch receptacle. Perform hand hygiene by handwashing with soap and water or the use of alcohol based hand sanitizer. Visit https://www.gov.mb.ca/covid19/prepareandprevent/index.html for the latest guidance from on use and care of masks. Also, visit the following Public Health Agency of Canada page to access a poster and guidelines for how to safely use a non-medical mask or face covering: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/covid-19-safely-use-non-medical-mask-face-covering.html

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Non-medical masks The use of non-medical masks (cloth or home-made masks) within child care settings is not recommended. However, some staff and children may choose to bring and wear a non-medical mask while in the facility. Masks are not recommended for children under two years of age. If a non-medical mask is used, hands should be cleaned before and after putting it on and taking it off. Follow the use of non-medical masks, including removal according to the recommendations for the use of medical masks above. Removed masks are considered contaminated and should be placed in a container or bag for appropriate cleaning/disinfection at a later time. Non-medical masks should be laundered daily. It is important to respect individual decisions and treat people who choose to wear a non-medical mask with respect. Family and staff can teach and reinforce these messages with the children. Those that choose to wear a non-medical mask should consider the limitations and information found here.

Documentation

Please use the form in Appendix A to notify us of any cases in your centre or changes to programs or services because of COVID-19. Please report on:

Confirmed or probable cases of COVID-19 involving staff, children in your care or family members of staff and children in your care. Probable cases have appropriate COVID-19 symptoms and a relevant exposure/ contact history. Confirmed cases have received a positive lab result from a provincial or national laboratory.

Significant changes to the services that your centre offers.

Any special measures your centre is taking to safeguard staff and clients. It is important that child care services continue to be delivered safely for staff and children. This can be done by ensuring staff and children consistently follow hygiene practices and other recommendations made by public health officials. When there are changes at your centre related to COVID-19, please send this form to cdcinfo@gov.mb.ca with the subject line: COVID-19 Incident Reporting.

Additional Resources

The following resources may support you in talking to children about COVID-19, as appropriate. These resources should not be viewed as, or used in the place of, public health advice.

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Resources on Talking to Children about COVID-19 Child Trends https://www.childtrends.org/publications/resources-for-supporting-childrens-emotional-well-being-during-the-covid-19-pandemic?utm_source=mailchimp&utm_campaign=030096d2e1f0&utm_medium=page UNICEF https://www.unicef.org/coronavirus/how-teachers-can-talk-children-about-coronavirus-disease-covid-19 Save the Children https://www.savethechildren.org/us/what-we-do/emergency-response/coronavirus-outbreak/coronavirus-outbreak-how-to-explain-children?utm_source=mailchimp&utm_campaign=030096d2e1f0&utm_medium=page

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Appendix A – COVID-19 Incident Reporting Form

COVID-19 Reporting Form

DATE: _____________________________________

Agency Information:

Name of agency: __________________________________________________

Contact name: ____________________________________________________

Contact information:

COVID-19 Information:

Please report the number of confirmed or presumptive cases of COVID-19 in your

agency and whether staff or clients have been affected:

Please provide information about any major changes to the delivery of services in

your agency:

Please provide additional information about what the agency is doing to ensure that

services continue to be delivered in a healthy way for staff and clients:

Instructions: please send this completed form to cdcinfo@gov.mb.ca.

Alternate formats available upon request